Otumdi Omekara, MD., MPAHA - Member of Society of Physician Entrepreneurs
Snoring is a noisy and often embarrassing behavior that deprives the snorer and his/her sleep partner of adequate sleep, causing them to have day time sleepiness and/or fatigue, plus other medical problems including heart attacks, strokes, diabetes, hypertension, etc.
§ It may be an indication of night time breathing obstruction or obstuctve sleep apnea (OSA)
§ 45% of normal adults snore occasionally while 25 % are chronic snorers
§ Men have more problem with snoring than women
§ Snoring is more common in overweight people and tends to worsen with age.
§ It requires the expensive attention of an otolaryngologist or ear, nose and throat specialist
§ A documentation of sleep study is required for health insurance coverage
Causes of Snoring
Obstruction to the free flow of air through the paharyngeal and laryngeal passages at the back of the mouth and nose.Snoring sound is produced when the tongue, upper throat, soft palate and uvula meet, strike each other and vibrate during breathingUnduely long soft palate, uvula or tongue produces fluttering noise in the throat during relaxed breathingMay be caused by enlarged tonsils and adenoids in chilren, or tumors (rarely)May also be caused by excessive relaxation of tongue and throat muscles during sleep, with the tongue falling back and the throat muscles sagging in from the sidesCould be worsened by muscle relaxant drugs including alcohol and sedativStrong vacuum effect needed to breath through a stuffy nose could suck in the side walls of the throat during relaxed sleep causing seasonal snoringNarrowing of one of the nostrils by the deviation of the partitioning nasal septum, may also have the same effect all year roundExcessive tissue in the throat of obese people tends to narrow down their airways
Causes of Obstuctive Sleep Apnea (OSA)
History of repeated episodes (30 –300) of occlusion of the airway for more than ten seconds may occur during deep sleep to produce obstructive sleep apnea.Once the patient startles up as a result of low oxygen supply to the brain, and changes position, the airway reopens and normal breathing resumesThe respiratory center could also momentarily cease firing from the mid brain, for a few seconds, for different reasons, with resultant sleep apneaWith increased frequency over time, OSA causes disruption of sleep cycle, chronic fatigue, and overworks the heart, which has to beat faster to meet the oxygen demant of the whole body tissues
Diagnosis of Obstructive Sleep Apnea
§ Loud and disturbing snooring calls for a consult with an ear, nose, and throat specialist or otolaryngologist to identify the cause(s) and rule out obstructive sleep apnea
§ Fiberoptic rhinophryngolaryngoscopy is done to examine the upper respiratory tract for possible cause of snoring
§ Sleep study is conducted in sleep labs or at home to document the existence and frequency of sleep apnea, especially for insurance purposes
Treatment of Snooring and OSA
§ Depends on the cause and the level of the airway narrowing or
§ The first step is usually to provide a continuous positive airway pressure (CPAP) machine which supplies minimal air pressure through a nasal caterher to the throat region to maintain a positive pressure, which prevents the airway from closing completely at any time.
§ Where that is no help, uvulopalatopharyngoplasty (UPPP) surgery is done by the otolaryngologist to remove redundant soft palate tisue and widen the airway.
§ The healing process after surgery stiffens the tissues and prevents undue vibrations
§ Repeated thermal ablation procedures using bipolar cautery, laser, and radiofrequency are also employed to surgically burn away obstructive polyps and redundant tisues in the nose and back of the mouth
§ Palate stiffening injections are also given to patients near the uvular to reduce the vibrations that cause the snoring sound
§ Pillar implants or stiffening rods may also be surgically inserted to reduce the vibrations that cause snoring
§ Genioglossus and hyoid advancement procedure surgically opens the obstructed airway bjy pulling the tongue muscles forward
§ Custom fit oral night guards, that reposition the lower jaw forward, are also being used for certain patients with snoring and/or OSA. This requires an experienced otolaryngologist, dentist, or oral surgeon to fit it safely and acurately
§ Weight loss through athletic lifestyle can improve snoring and OSA without the need for surgery
§ Elevating the bed head four inches is advised
§ Avoiding alcohol and tranquilizers can prevent excessive throat muscle relaation
§ Sleeping on the side rather than the back reduces snoring
§ OTC (over-the-counter) devices approved by FDA have their own claims toward the relief of snoring and OSA. Choosing the best from over 300 approved brands is the main challenge.